NPIMap

Individual provider Active NPI

Edward John Broccoli, MD

  • Anesthesiology Physician
  • Chappaqua, NY
National Provider Identifier
1609866060
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
1934481 Issued in NY
Practice address
16 S Bedford Rd
3W
Chappaqua, NY 10514-3464
Phone
(914) 844-2864
NPI assigned
Oct 26, 2005
Last updated
Jan 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 1934481 NY Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 1934481 NY

Addresses

Primary practice location

16 S Bedford Rd
3W
Chappaqua, NY 10514-3464

Mailing address

16 S Bedford Rd
3W
Chappaqua, NY 10514-3464
Phone (914) 844-2864

Other identifiers 6

IdentifierTypeStateIssuer
5398369OtherNYHEALTH NET
3129240OtherNYAETNA US HEALTHCARE HMO
5398370OtherNYGHI
8K819OtherNYEMPIRE BCBS
0004487677OtherNYAETNA US HEALTHCARE PPO
P2823545OtherNYOXFORD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080731000237 NY Practitioner - Anesthesiology 0648167247 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ramapo Anesthesiologists, PCGroup PAC ID 3476444373, 78 clinicians

Practice addresses (Care Compare)

Suffern, NY 10901
Phone (845) 357-5775

127 S Broadway
Yonkers, NY 10701-4006
Phone (845) 357-5775

622 W 168TH St
New York, NY 10032-3720
Phone (212) 305-9876

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1934481NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Mount Vernon Hospital CurrentSince Aug 2, 2022 Accepting new patients
Ramapo Anesthesiologists, PC Anesthesiology CurrentSince Jan 1, 2024 Accepting new patients
North Shore - Lij Anesthesiology, PC Anesthesiology CurrentSince Nov 5, 2023 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jan 23, 2024 Accepting new patients
New York Ambulatory Anesthesia, PLLC Anesthesiology CurrentSince Nov 7, 2025 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jan 23, 2024 Accepting new patients
Signature Integrated Medical Arts, PLLC Anesthesiology Past Accepting new patients
Nuvance Health Medical Practice PC PastSince Dec 19, 2015 Accepting new patients
Westchester Anesthesia LLC Anesthesiology Past Accepting new patients

Locations

16 S Bedford Rd
Ste 3W
Chappaqua, NY 10514
Phone (914) 238-5884

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

195 E Main St
Huntington, NY 11743
Phone (631) 385-8677

12 N 7th Ave
Mount Vernon, NY 10550
Phone (914) 361-6511

26901 76th Ave
New Hyde Park, NY 11040
Phone (718) 470-3000

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

1 Heroes Way
Riverhead, NY 11901
Phone (631) 548-6000

233 Lafayette Ave
Ste LL5
Suffern, NY 10901
Phone (914) 794-7741

127 S Broadway
Yonkers, NY 10701
Phone (914) 378-7342

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1609866060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 S BEDFORD RD",
            "address_2": "3W",
            "city": "CHAPPAQUA",
            "state": "NY",
            "postal_code": "105143464",
            "telephone_number": "914-844-2864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 S BEDFORD RD",
            "address_2": "3W",
            "city": "CHAPPAQUA",
            "state": "NY",
            "postal_code": "105143464",
            "telephone_number": "914-844-2864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCCOLI",
        "first_name": "EDWARD",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "1934481",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NY",
            "license": "1934481",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "5398369",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE HMO",
            "identifier": "3129240",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "5398370",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BCBS",
            "identifier": "8K819",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE PPO",
            "identifier": "0004487677",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2823545",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chappaqua, NY

Sources for this page

Verify at the official NPI Registry.